UNIT 10 Pediatric Head Trauma & NEUROSENSORY Flashcards
Which of the following places should you as a nurse should be suspicious if you 8-month-old patient appears with bruising? SELECT ALL THAT APPLY
A. Toe nails
B. Buttox
C. Ears
D. Hand
E. Neck
F. Torso
C. Ears
E. Neck
F. Torso
What can trigger an individual to cause pediatric head trauma to a child
◦ Crying baby
◦ Misbehavior
◦ Argument/conflict
◦ Toilet training
◦ Parental stressors
◦ Discipline gone awry
What families are overlooked when it comes to pediatric abuse?
◦ Caucasian families
◦ “Intact” families
◦ Middle class, well educated families
◦ Families perceived to be like our own
◦ Very young infants
◦ Infants with non-specific symptom
What is the nurses responsibly when it comes to Pediatric Trauma and the prevention thereof?
◦ Report to CPS if suspected abuse
◦ Document signs/symptoms of abuse
◦ Take pictures of injuries
◦ Document information from caregiver when you have
suspicions
◦ Document observations of the parent and child,
including interactions
◦ Help parents understand that it is normal For babies to cry
◦ To feel frustrated and need help to cope
◦ Be a resource for the family
◦ Talk openly about dangers of shaking a baby
What can you do to soothe a a crying baby to prevent shaking syndrome?
- change diaper
-feed baby
-assess if the baby is sick or injured - rock, walk , or dance with baby
-drive with baby in car seat
-white noise(distraction music)
-if you are frustrated from the baby walk away, put baby in crib that is clutter free
What is Abusive head trauma commonly referred to?
Also known as Shaken Baby Syndrome
What is the number one risk factor for Shaken Baby Syndrome?
Caused by violent shaking
* #1 risk factor: crying
* Damage caused by shearing forces in head
* Often no external injuries present
* Medical attention sought for apnea, irritability, lethargy, seizure
Nursing consideration when talking to pediatric patients about abuse?
- Provide private place to talk
- Do not promise not to tell
- Avoid leading questions
- Red flags for abuse:
- Parent answers questions asked of child
- Injury does not match story; changing stories
- Parent/child stories do not match
- Inappropriate response from child
- Parent refusing treatment or testing
What is the number one priority in a pediatric patient who is diagnosed with Attention Deficit Hyperactivity Disorder?
Safety due to impulsiveness
S/S of ADHD
Behavioral disorder characterized by develop-
mentally inappropriate degrees of inattention,
overactivity, and impulsivity
Fidgets with hands or feet or squirms in the seat
Easily distracted with external or internal stimuli
3. Diffculty with following through on instructions
4. Poor attention span
5. Shifts from one uncompleted activity to another
6. Talks excessively
7. Interrupts or intrudes on others
8. Engages in physically dangerous activities without considering the possible consequences
How do manage ADHD
- Behavioral therapy; positive reinforcement
- Organizational charts
- Frequent breaks
- Medication(Methylphenidate ) Cns depressant
- Safety measures due to impulsivity
Is Down syndrome congenital or acquired?
congenital
Trisomy 21
* Etiology: unknown. Risk statistically greater if maternal age over
35
Your pediatric patient who is 2 months old has comes in for a check up due to a possibility of having downsydrome. Which of the following manifestations will confirm this suspicion?
A. Downward started eyes
B. hypertonicity
C. hypo flexibility
D. depressed nasal bridge
D. depressed nasal bridge
S/S OF DOWNSYNDROME
* Low birth weight
* Hypotonicity
* Short stature
* Hyperflexibility
* Depressed nasal bridge
* Protruding tongue
* Short, stubby digits
* Upward slanted eyes
Your pediatric patient has came him for a check up. The mother states that her child has had difficulty making eye contact with her. Which of the following disorders would you suspect this child to have?
A. Kawasaki syndrome
B. Ventricular Septal defect
C. Autism
D. Attention Deficit Hyperactivity Disorder
C. Autism
S/S of autism
Manifestations: Inability to maintain eye contact
- Failure to interact socially, communicate appropriately
- Early red flags: no smile by 3 mos,
*no eye contact,
*no babbling by 12
mos, - no words by 16 mo
How do you manage autism?
- Determine the child’s routines, habits, and preferences, and maintain consistency as much as
possible. - Determine the specific ways in which the child
communicates, and use these methods. - Avoid placing demands on the child.
- Implement safety precautions as necessary for
self-injurious behaviors such as head banging. - Initiate referrals to special programs as required.
- Provide support to parent
DECREASE STIMULATION
What is a classical sign of a brain tumor
Headache (especially upon awakening), vomiting, nystagmus, vision
changes
Your pediatric patient’s mother has noticed that the front center of the top of head has gotten bigger she described it as a “bulged appearance”. What disorder do you suspect can be going on with the patient?
A. Sickle cell disorder
B. Increased Intracranial pressure
C. Hemophilia A
D. Kawasaki syndrome
B. Increased Intracranial pressure
Increased Intracranial Pressure
Pressure accumulated in cranium due to CSF or blood
* Fontanel accommodates for some increase in infancy
* Early manifestations may be subtle
Signs and symptoms of Increased Intracranial pressure
Manifestations
* Bulging fontanels
* Shrill cry
* Separated suture lines
* Increased head circumference
* Irritability
* Distended scalp veins
* Drowsiness Headache
* Lethargy
* Vomiting (forceful)
How do you manage Increased Intracranial Pressure
Management:
* Direct ICP monitoring
* Osmotic diuretics (Mannitol)
* Positioning- HOB 15-30
* Cluster care(DO EVERYTHING AT ONCE TO LESSON STIMULATION)
* Quiet, dimly lit environment
* No airway suctioning unless necessary
* Strict I&O
What I the number one first nursing intervention. when you suspect that a child may have head injury?
Neurologic exam to check neurological status
Vital signs
* Temperature
* BP/HR- changes in these are more important than direction they are
headed
* RR- often deep and irregular
* Pupils- PERRLA?
* LOC
* Motor function- spontaneous vs to painful stimuli
* Posturing- occurs when control of motor function is lost
Your pediatric patient has just entered the trauma unit from a motor vehicle accident. You notice a postering that shows that his hands are centered and held tightly in his core/body. What would you suspect this child posturing to be?
A.Decorticate
B.Decerebrate
A.Decorticate
What is the definition of Decorticate posturing
Rigid flexion with arms held tightly
to body; legs extended and rotated
inward
